冠脉旁路移植术及同期心脏瓣膜置换手术20例.docVIP

冠脉旁路移植术及同期心脏瓣膜置换手术20例[摘要] 目的 总结同期实施冠脉旁路移植与心脏瓣膜置换手术的危险因素、治疗效果和临床经验。方法 2006年1月至2009年4月我科同期实施冠脉旁路手术和心脏瓣膜置换手术20例,均于体外循环下实施。其中冠状动脉病变合并心脏瓣膜疾病12例,风湿性心脏瓣膜疾病合并冠状动脉疾病8例,合并左心房血栓2例。结果 术后5例发生低心排,4例成功救治(其中3例予主动脉内球囊反搏支持),1例因多器官衰竭死亡;再次开胸止血1例。19例患者心脏功能明显改善,临床治愈出院;术后随访1~38个月,无死亡事件,患者生活质量明显改善。结论 同期实施冠状动脉旁路手术和心脏瓣膜置换手术是可行有效的,手术近期效果令人满意。? [关键词] 冠心病;心脏瓣膜疾病;心脏瓣膜置换;冠状动脉旁路移植? [中图分类号] R654.1[文献标识码] A [文章编号] 1671-7562(2009)06-0412-03?? Combined coronary bypass grafting and cardiac valve ?replacement:report of 20 cases? WANG Wei,ZHANG Kai?guang,WANG Bao?yi,SHI Wei,MIAO Bing?rong,ZHANG Wei (Department of Cardiovascular Surgery,Xuzhou Hospital,Affiliated to Medical College of ?Southeast University,Xuzhou 221009,China)?? Abstract:Objective To investigate the risk factors,the clinical experience and the early results of combined coronary bypass grafting(CABG) and cardiac valve replacement.Methods From Jan.2006 to Apr.2009,combined CABG and valve replacement were performed in 20 patients.Twelve patients were coronary artery disease with valvular dysfunction,and 8 patients were rheumatic heart disease with coronary stenosis,2 patients with left atrial thrombus.All patients were in the off?pump surgery.Results Five casesoccurred postoperative low cardiac output,3 of them were given intra?aortic balloon pump support.One cases died due to multiple organ failure.One cases of re?thoracotomy to stop bleeding.Nineteen cases cardiac function were significant improvement,who were followed up for 138 months,no deaths was found.The quality of life of the patients were improved markly.Conclusion Combined CABG and valve replacement surgery is feasible and effective,short?term effect of satisfaction with the surgery. Key words:coronary artery heart disease;valvular heart disease;heart valve replacement;cornary artery bypass grafting? (Modern Medical Journal,2009,37:412-414)?? 单纯的冠状动脉(冠脉)旁路移植手术和心脏瓣膜置换手术已经成为常规心脏外科的治疗手段。高龄风湿性心脏瓣膜疾病,特别是年龄超过50岁者可能同时合并冠心病;冠心病患者也可合并心脏瓣膜疾病。这类患者往往需同期实施冠脉旁路移植手术和心脏